Summary: A case study showing how social determinants impacting health outcomes work in different zip codes and how these manifest in an urban neighborhood in southwest Atlanta.

Perhaps the single most sobering insight to arise from How Neighborhoods Make Us Sick is that life expectancy within different zip codes in the same city and metro area can widely vary–by a decade or more in some cases. There are a complex of factors in which these areas vary–social determinants–that profoundly affect the wellness and longevity of the residents in those neighborhoods.

The co-authors of this book, Veronica Squires and Breanna Lathrop, take academic discussion in the public health community and narrate how they personally experienced the realities of the factors that shape health outcomes. Their argument is that these social determinants go far beyond personal choices and “bootstrap” solutions. Much of this came through their personal realization that the presence and community involvement advocated in community development circles just weren’t enough. The first half of this book describes the journey of each of them in coming to this realization. Each chapter contains a sections describing the journey of each author around the impacts on health of poverty, employment (mostly in low wage jobs), food insecurity and nutrition, education and child development, housing availability, environmental issues (mold, lead), and homelessness, and health care access.

Breanna, a health care provider at the Good Samaritan Health Center in urban southwest Atlanta, came face to face with the reality that all her efforts at appropriate health interventions and care plans were being undone by these social determinants. Her patients were not getting better. Veronica and her husband moved into the neighborhood, lived out the commitments they had learned in community development, but little changed and both saw their own health deteriorate, despite having good educations and jobs. After nine years, they had to move out. Veronica writes:

“I left with severe anxiety, major depression, and recurrent panic attack episodes. Eric left with panic attacks too, along with high blood pressure and heart palpitations. We both left with psoriasis. Yet, even though I knew we were doing the right thing for the health of our family, I was grieving the loss of a vision and hope that community development alone could repair communities in a holistic, lasting, and scalable manner. As we pulled onto the highway, I turned around to look at the exit I had taken thousands of times to get home and thought, There has to be a better way to restore our communities.” (p. 89)

Part Two of the book begins with the co-authors writing about how they leaned into their faith in addressing these challenges. Their study of Jesus opened their eyes to his commitment to healing and overturning oppressive systems and structures that undermined the health and lives of the poor. They saw that to pursue this work was kingdom work.

Both describe the transformative practices they’ve had a part in implementing at the Good Samaritan Health Center, a donor-funded effort. Veronica is the chief administrative officer, and Breanna, the chief operating officer. They make some challenging statements about some of the mantras surrounding charitable giving in church circles, including volunteering as a substitute for giving, and “diversifying.” The health center itself offers a “full circle” of health care including medical and dental care, behavioral health care, health education, and healthy living practices.

Most strategic though are the partnerships they have developed to address housing issues, employment, health care for the homeless, nutrition (through neighborhood food initiatives and gardens), and a focus on early child development and education. They stress the importance of partnering with the community, listening to the community for its advice about what will be most helpful. They also address the issue of health access and insurance in the U.S. and the current decisions that exclude many from access to good health care, particularly preventive care. They argue that many of the interventions they have pursued save money, or even return money to communities, compared to the current alternatives that often result in repeat incarceration, emergency room usage, and hospitalizations.

It struck me that these women, and those they work with did not stop with the many reasons why things weren’t changing in southwest Atlanta, but looked for smart and biblical ways to pursue health equity, addressing the other factors that often undermined their patients’ health. They hit bottom, were honest about what that looked like for them, and then persisted.

The book also raises questions about whether we will recognize that equality is not enough when the playing field is not level. They advocate for health equity, recognizing that those at the bottom of the hill face a much harder task than those at the top to achieve the same outcome. Will a nation graced with so many resources rise to this kind of greatness? And to come back to the sobering insight with which I began, how will we respond to the fact that some of our near neighbors in the same city have a shorter life expectancy than we do? How is this not a pro-life issue? These were the questions I’m pondering after reading this book.

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Disclosure of Material Connection: I received this book free from the publisher. I was not required to write a positive review. The opinions I have expressed are my own.